Dear Graduate Student,
Congratulations on progressing to this point in your program of study where you are poised to form your doctoral supervisory committee!
The memorandum that follows is a sample. It is meant to serve as an example of how you might compose your request. Note that the directives are broad and abstract to purposely accommodate diversity of interest.More guidance can be found on the School of Nursing website:
Approval Required by Proposed Chair
Please work with your proposed chairperson in preparing thismemorandum. You are certifying that the proposed chair has overseen the development of and approved of the request.
Purpose of the Memorandum
Yourmemorandumshould serve as a reference document, not only for your proposed and eventual committee members, but also for the School of Nursing and the UW Graduate School. Your finished memorandum should reflect that you understand the purpose of the Supervisory Committee and roles of its members. Additionally, the memorandum should reflect that you are clear about your own role in the PhD degree program and your focus of study.Your finished memorandum should also demonstrate that you are able to concisely articulate the purpose of your proposed work, the expertise and strengths of your proposed committee members, and what type of guidance to expect of them as they supervise and mentor you throughout your dissertation process. (This is an example memorandumonly. It includes verbiage for a chair, GSR, and two committee members. Please revise as needed to reflect your proposed committee membership.)
The Graduate School Representative
Please read carefully about the role and responsibilities of the Graduate School Representative (GSR). The GSR is on your committee to make sure that you are treated fairly and that the process is rigorous. The GSR does not need to have expertise in your research area. Please see:
How to Submit
Before submitting your finished memorandum to the Associate Dean for Academic Affairs, please delete this page of instructions.Submit the completed memo as an e-mail attachment to with a copy to yourself and your proposed chairperson.
I hope these instructions are helpful to you as you prepare your memorandum!
Thank you,
Anne Hirsch, PhD, ARNP, FAANP, FAAN
Associate Dean for Academic Affairs
Date:DATE HERE
To:Anne Hirsch, PhD, ARNP, FAANP, FAAN
Associate Dean for Academic Affairs
From:STUDENT NAME HERE
Pre-doctoral student, PhD degree program
Subject:Appointment of Supervisory Committee
I respectfully request review for approval of the below-named faculty members for my Supervisory Committee and, if approved, subsequent forwarding of this request to the Dean of the UW Graduate School.
ResearchInterest: (100 word limit.) My research interest is in <interest area here>, specifically as it relates to <specifics here>. I tentatively intend to work with <population or agency or other here>. The proposed outcome of my research will be <describe here>.
Tentative Quarter and Year of Dissertation Proposal Approval by Supervisory Committee: XXXX Quarter 20XX.
Certification: I certify that the proposed Chairperson below has thoroughly evaluated the appropriateness of each proposed committee member and approves of this request as written.
Proposed Supervisory Committee
CHAIRPERSON
Name:NAME HERE, DEGREE/LICENSES/OTHER HERE
Title:PROFESSORIAL RANK HERE, DEPARTMENT HERE
Profile (70-word limit): Dr. XXXXX's area of expertise is <describe briefly here, including faculty member's academic preparation and research interests.
Analysis of how the above-named faculty member will contribute to the specific aims of my program of study and academic goals (70-word limit): (Write your analysis here.)
GRADUATE SCHOOL REPRESENTATIVE
Name:NAME HERE, DEGREE/LICENSES/OTHER HERE
Title:PROFESSORIAL RANK HERE, DEPARTMENT HERE
Profile (70 word limit): Dr. XXXXX's area of expertise is <describe briefly here, including faculty member's academic preparation and research interests.
Conflict of Interest Statement:Dr. XXXXX is a member of the UW Graduate Faculty with an endorsement to chair. Dr. XXXXX has no conflict of interest in serving on my committee, including but not limited to budgetary relationships, personal relationships, or research and/or publication relationships between the GSR and either the student or the Supervisory Committee chair. I affirm my understanding that the GSR is responsible for ensuring that no such conflicts of interest or the appearance of conflicts of interest exist and will be able to attest to this upon request.
MEMBER
Name:NAME HERE, DEGREE/LICENSES/OTHER HERE
Title:PROFESSORIAL RANK HERE, DEPARTMENT HERE
Profile (70 word limit): Dr. XXXXX's area of expertise is <describe briefly here, including faculty member's academic preparation and research interests.
Analysis of how the above-named faculty member will contribute to the specific aims of my program of study and academic goals (70 word limit): (Submit analysis here.)
MEMBER
Name:NAME HERE, DEGREE/LICENSES/OTHER HERE
Title:PROFESSORIAL RANK HERE, DEPARTMENT HERE
Profile (70 word limit): Dr. XXXXX's area of expertise is <describe briefly here, including faculty member's academic preparation and research interests.
Analysis of how the above-named faculty member will contribute to the specific aims of my program of study and academic goals (70 word limit): (Submit analysis here.)